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Evaluación del papel de la pupilometría cuantitativa en el hematoma subdural crónico: Un estudio piloto
Lukas Klein1,2, Christopher Beynon2,3, Daniel Kühlwein2,3
1Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Brain & spine
|February 4, 2026
Resumen
La pupilometría cuantitativa (PC) no detectó cambios en la presión intracraneal en pacientes de edad avanzada con hematoma subdural crónico (HSC). La atrofia cerebral puede enmascarar elevaciones de la presión, lo que requiere una investigación adicional para la detección y el manejo tempranos del HSC.
Área de la Ciencia:
- Neurología
- Neurocirugía
- Geriatría
Sus antecedentes:
- La incidencia de hematoma subdural crónico (HSC) aumenta con el envejecimiento de la población.
- La atrofia cerebral en personas de edad avanzada crea una reserva intracraneal, que puede enmascarar una presión intracraneal (PIC) elevada.
- Los métodos no invasivos para la detección y el monitoreo tempranos del HSC son cruciales.
Objetivo del estudio:
- Investigar la utilidad de la pupilometría cuantitativa (PC) en la detección de cambios sutiles de presión o compromiso neurológico en pacientes de edad avanzada con HSC.
- Evaluar si la pupilometría puede servir como un biomarcador no invasivo para el HSC en adultos mayores.
Principales métodos:
- Estudio prospectivo de 26 pacientes de edad avanzada con HSC (65-97 años) sometidos a tomografía computarizada (TC) craneal y evacuación quirúrgica.
- Pupilometría pre y postoperatoria utilizando el Pupilómetro NPi 200® para medir el Índice Pupilar Neurológico (NPi).
- Comparación estadística del NPi con parámetros clínicos (Escala de Coma de Glasgow - GCS) y radiológicos (volumen del hematoma, área de cavidad residual - RCA, índice de Evans).
Principales resultados:
- No se encontraron diferencias estadísticamente significativas al comparar directamente el NPi con la GCS, el volumen del hematoma, el RCA, el índice de Evans o los déficits motores.
- El área de la cavidad residual (RCA) mostró correlaciones positivas significativas con la edad, el índice de Evans y el volumen del hematoma.
- Se observó una tendencia hacia una correlación negativa entre el volumen del hematoma y el NPi del ojo izquierdo, y entre el RCA y la GCS.
Conclusiones:
- La pupilometría no reveló respuestas anormales en esta cohorte de pacientes de edad avanzada con HSC.
- La reserva intracraneal debida a la atrofia cerebral puede prevenir la PIC elevada a pesar de grandes volúmenes de hematoma.
- Se necesita más investigación para identificar biomarcadores que mejoren la detección y el manejo tempranos del HSC.
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